Work is a key clinical outcome

A return to work is, for most patients, a positive clinical
outcome, and sometimes, an intervention in its own right.

'Employment is Nature's physician, and is essential to
human happiness'

Galen of Pergamon, Greek physician, surgeon and
philosopher, 172 AD

As the quote from Galen, the Greek physician shows, it has long
been recognised that work, be it paid or unpaid, plays a central
role in the health and well-being of most people. We know
that work gives us material rewards, but it also gives people a
sense of identity and connection with others in our society; it
gives us a sense of personal achievement; it is a means of
structuring and occupying our time and helps us to develop mental
and physical skills. Work also provides us with the financial
and material resources necessary for our daily lives.

Of course work sometimes has negative connotations. Some
workplaces are associated with stress where choice in activity is
limited and the work culture is one of bullying and harassment,
particularly for people with a mental health condition.
Despite this, research studies have found that unemployed
people do not exploit the extra time on their hands to follow
leisure and social pursuits. Instead unemployment is
associated with increased apathy, a shrinking social circle and
decreased motivation. The consensus is that being out of work
causes ill-health and that poor health tends to deteriorate when a
person is not working. This sets up a vicious circle which
reduces the chances of a person returning to work.

Work and employment are important for health and
well-being

We know that many people with a mental health
condition do not participate in key activities of society, they are
socially excluded, and that being in work can reduce the likelihood
of this. The right work, with the right support from
employers, colleagues, carers and health and care professionals can
actually aid recovery for people with mental health problems.
No one is intrinsically unemployable, studies show that,
given the right conditions and support, the vast majority of people
who are out of work and use mental health services want to return
to or to start work. However, people with mental health
problems do face significant challenges when trying to access
employment. Some of these challenges are shared with other
people such as the need to adjust the physical environment, or to
mitigate language difficulties or the need for extra support or
training. However, often these obstacles are less tangible
owing to some differences between mental health problems and other
impairments:

They are not immediately obvious and can develop
at any time in a person’s life

They attract fear and prejudice e.g. myths of
incompetence or dangerousness

They typically fluctuate and it can be difficult
to predict when these fluctuations will occur

They affect a person’s ability to negotiate the
social, rather than the physical world of work.

The right employment can improve mental health
and protect against relapse.

Remember also that many people who are working also experience
mental health problems and may have periods of ill-health whilst at
work thus contributing to presenteeism and absenteeism.

The comprehensive systematic review of the research evidence
carried out by Waddell and Burton, 2006, concluded that in
general:

Work is beneficial to health and
well-being

Lack of work is detrimental to
health and well-being leading to higher consultation rates with GPs
than in the general population, increased prevalence of depression
and anxiety and higher suicide rates.

For people without work,
re-employment leads to improvement in health and well-being,
whereas continued unemployment leads to deterioration

For people who are sick or
disabled, placement in work improves health and psychosocial
status

The health status of people of
all ages who move off welfare benefits improves

These benefits apply equally to
people who have mental health problems including those with severe
mental health problems.

There is no evidence that work is
harmful to the mental health of people with severe mental
illness.